TKA Indications

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TKAIndications

• Pain and disfunction severe enough to justify
  surgery
• X-ray correlation joint damage beyond repair by
  other means
• Patient good understanding of what to expect from
  surgery

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TOTAL KNEE REPLACEMENTWhen?

• Pain
• Function
• LOM
• Level of disability

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TOTAL KNEE REPLACEMENTHow?

• Fixation
• Cement
• Cementless
• Incision approach
• Limited minimal
• Prosthetic choice

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TKAThings to consider

• Patients age
• Occupation and activity level
• Surgeon ability
• Patient desires

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TKATYPES

• Unicompartmental
• Tricompartmental
• - Posterior cruciate retaining
• - Posterior cruciate substituting
• Hinge

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UNICOMPARTMENTAL

• Medial-lateral
• Single comp. Disease
• Good ligaments
• Limited activity
• Patellofemoral
• Only PF disease
• No patellar maltracking
• Few candidates

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TKATYPES

• Tricompartmental
• Non modular
• Modular
• Rotating platform

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TOTAL KNEE ARTHROPLASTYSurgery

• 1-2 hr surgery
• 3-5 days hospitalization
• More discomfort than hip
• Rehabilitation a bit harder

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TOTAL KNEE ARTHROPLASTYAnesthesia

• Regional or general
• Femoral n. block (continuous)Sciatic n. block
• postop analgesia

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TOAL KNEE ARTHROPLASTYRecovery

• 4-6 wks walker / 2 crutches
• Wait for wound healing to FWB
• Physical therapy advisable

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TOTAL KNEE ARTHROPLASTYExpectations

• 95 satisfaction
• Slightly less than THA
• 20 yrs longevity
• Ability to walk distances
• Bike, horseback riding yes
• Skiing, running, jumping no

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TOTAL JOINT ARTHROPLASTYMinimally Invasive
Surgery

• Same surgery, smaller incision
• Technically more demanding
• No proofs that recovery is better, faster or less
  painful
• No long-term data

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TOTAL JOINT REPLACEMENTHIP AND KNEEConclusions

• Pain relieving and function improving procedures
• Predictable results

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TOTAL JOINT REPLACEMENTHIP AND KNEEWho Should
Do It?

• Proper training
• Over 50/yr